McGrath videolaryngoscopy versus direct laryngoscopy for rapid sequence intubation: A multicenter randomized clinical trial.

BACKGROUND

Videolaryngoscopy has been proposed to improve glottic visualization and intubation success during rapid sequence intubation (RSI). Evidence on the effectiveness of the McGrath videolaryngoscope in this setting remains limited.

METHODS

In this multicenter, patient-blinded, randomized trial, 400 adults undergoing elective non-cardiac surgery requiring RSI were assigned to McGrath videolaryngoscopy (VL, n = 193) or direct laryngoscopy (DL, n = 201). The primary outcome was glottic visualization using the modified Cormack-Lehane (CL) classification. Secondary outcomes included first-attempt intubation success, number of attempts, intubation failure, and time to intubation. Safety outcomes included airway injury and postoperative complications.

RESULTS

Glottic visualization did not differ significantly between groups (Grade 1 view: VL 46.6% vs DL 42.3%; OR 1.24, 95% CI 0.85-1.79; P = 0.26). First-attempt success was similar (VL 86.5% vs DL 87.6%; P = 0.76). Intubation failure occurred in 1.6% of VL and 0.5% of DL cases (P = 0.29). Median time to intubation was longer with VL (35 s vs 30 s; HR 1.27; 95% CI 1.04-1.56; P = 0.016). Rates of airway trauma and postoperative complications were low and comparable.

CONCLUSIONS

In adult patients undergoing RSI, McGrath videolaryngoscopy did not improve glottic visualization or first-pass intubation success compared with direct laryngoscopy, and was associated with a modestly longer intubation time. Adverse events were infrequent and similar. These findings suggest that the routine use of McGrath for RSI may not confer clinical benefit in low-risk elective surgical populations.